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Home-based tele-mental health benefits Veterans

Leonard E. Egede, M.D., is a VA researcher heading the investigation at Charleston VAMC; he is also director of the MUSC Center for Health Disparities.

By Special to the Ralph H. Johnson VA Medical Center

Monday, January 2, 2017

Home-based tele-mental health care for depression is well received by patients and delivers as good a quality of life as in-person visits, according to the results of a clinical trial in 241 depressed elderly Veterans reported in the Journal of Clinical Psychiatry by investigators at the Ralph H. Johnson VA Medical Center (VAMC) and the Medical University of South Carolina.

Depression affects 10 percent of Americans and is a leading cause of disability and mortality. And yet, only an estimated 56 percent of patients with depression seek treatment. Barriers to treatment include mobility issues (especially in the elderly), transportation costs, missed days of work, geographic isolation, and fear of the associated stigma. By overcoming some of those barriers, tele-mental health could improve access to care for these patients.

“This is the largest randomized clinical trial to date examining whether differences exist in patient perceptions, satisfaction, therapeutic alliance, and quality of life between tele-mental health and same-room care,” said VA Investigator Leonard E. Egede, M.D., who is also director of the MUSC Center for Health Disparities.

The study included male and female Veterans aged 58 years and older who met the criteria for major depressive disorder (DSM-IV). All participants received eight weeks of behavioral activation therapy and were randomly assigned to tele-mental health or in-person counseling. Behavioral activation reflects the notion that the patient's activity plays a role in how he or she feels and the goal of therapy is to reduce behaviors that promote depression.

Tele-mental health treatment sessions were delivered via in-home videoconferencing using a standard telephone line and did not require an internet connection. The 36-item Short Form Survey was used to assess quality of life and the Charleston Psychiatric Outpatient Satisfaction Scale was used to assess patient satisfaction. Scores on these scales did not differ significantly at 12-month follow-ups between Veterans who received depression care via tele-mental health and those who received in-person care.

Two previous studies conducted by Egede showed treatment response and costs for tele-mental health care are similar to those of in-person depression care. This study shows that tele-mental health also delivers similar quality of life and patient satisfaction, suggesting it is a viable alternative to in-person visits for treating elderly patients with depression.

“It is time for tele-mental health to take its rightful place alongside in-person counseling as a viable option for depression care, one that will remove many barriers to care,” Egede said.

Dr. Egede working with a mental health provider.

This article is a special feature for The Ralph H. Johnson VA Medical Center.